After20 years in the field advising practices of every size and market position � from rural soloists to urban market leaders � here are the biggest mistakes I�ve seen even the smartest ophthalmologists make in their first years of practice. While most of these points are germane to doctors joining established practices, many of them apply to those few rugged individuals who are still going out to establish their own practices from scratch.

1. If you�re a partner-track associate, don�t act like an employee.

I talk to a lot of senior employer doctors each year who are unhappy about their new associates. The most common complaint isn�t about clinical skills, but about junior doctor behavior. Lapses include dating staff, discussing confidential practice business matters in the community, or grumbling openly about salary. Decide if you�re going to be a practice owner or employee in the future, and then behave accordingly.
2. Don�t assume you�re doing a great job.
   
If you haven�t been given one already, prepare a list of things you�d like to accomplish in your first year or years of practice and share them with your employer. Be sure to include extracurricular duties (screenings, community involvement, etc.). Check in with each other, at least quarterly, to compare notes on how you�re doing.
3. Don�t adopt a lesser work ethic than your boss.

The average managing partner in a group-practice is working much harder than ever before both to maintain personal clinical productivity as well as manage the practice. While he or she is pulling hard in the harness, the last impression you want to leave is that they�re dragging you along for the ride. Increasingly, it�s expected that you�ll be willing to work Saturday mornings or weekday evenings, take extra calls and travel to outlying satellites. Discussing ways to grow your practice at an even faster pace is understandably attractive to any employer.
4. Don�t be immature.

Some practices will hire only mid-career surgeons based on a few bad experiences with breaking in young doctors. Show maturity in your attire, language, behavior and follow-through. Look older than your age. Don�t be defensive when you�re told to shape up. Improve both the quality and impression of quality of who you are.
5. Don�t stop your education.

We�re all paid for value. Make yourself continuously more valuable by learning new skills, either formally through mini-fellowships or informally through self-education on the job. If your boss likes to teach, draw on this resource. Even if you�re learning at a slower pace than you would in a more formal setting with a big-name professor, the contact time will provide invaluable secondary benefits.
At the same time that you�re building on a clinical skills foundation, develop a new baseline of competency in management skills, formally through M.B.A.-level courses or informally through readings, visiting advisers and exposure to successful practices.
6. Don�t be a loner.
   
Many practices are or will soon be scaling up via consolidation into much larger single- and multispecialty organizations. You should be able to work on a multidisciplinary team and defer to group decisions.
7. Don�t be overly complacent or overly frightened about managed care
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It�s your job to understand the dynamics of your market, help your practice gain panel access and commit significant personal time to making a transition to survival in a world where more patients are seen under managed care contract terms. Managed care won�t mean the end of civilization or even of entrepreneurial medicine, but it will force the winners to significantly fine-tune their game.
8. Don�t live on more than 70% of your net after-tax income.
   
If you start investing now, even with falling fees, you�ll retire comfortably in your 50s or earlier if you desire. Steady wins the race. History shows that regular, level contributions to broad-index funds, along with a modest tapering of personal expenses, can easily yield a secure retirement. Watching your net worth rise year after year is a powerful antidote to the uncertainty of modern ophthalmology.
9. Don�t ignore your spouse.
   
Chances are, you�ve both sacrificed getting you to this point in your career. It�s payback time not just economically but, more importantly, in terms of time together and attention to your spouse�s career as well as personal and family building interests. The comparative sudden flush of cash combined with new surroundings and temptations can destabilize even the strongest medical marriages.
10. Once you�ve decided to leave, don�t stick around.
    
Some of you may be considering a job change. A few of you may have been on the edge of departure for some time. You�re a trained surgeon � so be decisive. And don�t get overly hung up about appearing to be flighty to your next employer. Career and job changes, which have long been common in the business world, will become increasingly common for ophthalmologists.

These ten tips all relate to specific actions or activities to avoid. Their common denominator is that they flow from your own decisions � not from external forces over which you have no control. If you keep in touch with yourself and take responsibility for your actions, your ultimate success will be as inevitable as your occasional slip-up.